Division of Respiratory Diseases, State Key Laboratory of Biotherapy of China & Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Laboratory of Clinical Genetics & Department of Respiratory and Critical Care Medicine, Affiliated Hospital & Clinical College of Chengdu University, Chengdu, Sichuan, China.
Int J Clin Pract. 2021 Sep;75(9):e14415. doi: 10.1111/ijcp.14415. Epub 2021 Jun 9.
There is limited evidence of the relationship between peripheral blood eosinophils and clinical remission of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) at different ages, especially in elderly patients, which was the objective of the present study.
This retrospective study stratified patients by age (elderly patients >65 years old or middle-aged patients between 45 and 65 years old) and analysed the relationship between blood eosinophils (≥2% or <2%) and AECOPD clinical remission at observing time points of 7, 14, 21 and 28 days of hospitalisation. Student's t tests, Mann-Whitney U tests, Chi-squared or Fisher's exact tests were conditionally used to compare difference between groups. The unadjusted or adjusted Cox proportional hazards model was used to analyse the association between blood eosinophilic levels and cumulative clinical remission.
Of 703 AECOPD cases analysed, 616 were elderly people (>65 years), 312 of whom had eosinophilic exacerbations. There were statistically significant differences in leucocytes, eosinophils, neutrophils, lymphocytes, monocytes, high-sensitivity C-reactive protein levels (hs-CRP), and hospital costs between groups (P < .05, respectively). According to the chi-square analysis, eosinophilic exacerbation had a higher clinical remission rate at 7, 14 and 21 days (all P < .05), but not 28 days (P > .05). Among analysis through adjusted Cox proportional hazards model, eosinophilic exacerbation was significantly associated with a higher cumulative remission rate in elderly patients at 7, 14, 21 days (all P < .05), but not 28 days (P > .05). No significant association was observed in meddle-aged patients at any time points (all P > .05).
Eosinophilic exacerbation was associated with better early clinical remission of AECOPD patients during hospitalisation. As stratified by ages, similar results were observed in elderly patients but not middle-aged patients. Blood eosinophils at different ages may be valuable in personalised management for AECOPD.
外周血嗜酸性粒细胞与慢性阻塞性肺疾病急性加重（AECOPD）不同年龄段临床缓解的关系证据有限，尤其是在老年患者中，这是本研究的目的。
本回顾性研究按年龄（老年患者>65 岁或中年患者 45-65 岁）分层，并在住院观察 7、14、21 和 28 天时分析血嗜酸性粒细胞（≥2%或<2%）与 AECOPD 临床缓解的关系。有条件时使用学生 t 检验、Mann-Whitney U 检验、卡方或 Fisher 精确检验比较组间差异。使用未调整或调整的 Cox 比例风险模型分析血嗜酸性粒细胞水平与累积临床缓解的关系。
在分析的 703 例 AECOPD 病例中，616 例为老年人（>65 岁），其中 312 例为嗜酸性粒细胞性加重。白细胞、嗜酸性粒细胞、中性粒细胞、淋巴细胞、单核细胞、高敏 C 反应蛋白（hs-CRP）水平和住院费用在各组之间存在统计学差异（P<0.05，分别）。根据卡方分析，嗜酸性粒细胞性加重在 7、14 和 21 天时临床缓解率更高（均 P<0.05），但在 28 天时（P>0.05）则不然。通过调整后的 Cox 比例风险模型分析，嗜酸性粒细胞性加重与老年患者在 7、14、21 天的累积缓解率显著相关（均 P<0.05），但在 28 天则无显著相关性（P>0.05）。在任何时间点，中年患者均未观察到显著相关性（均 P>0.05）。
嗜酸性粒细胞性加重与 AECOPD 患者住院期间的早期临床缓解相关。按年龄分层，在老年患者中观察到相似结果，但在中年患者中则无。不同年龄的血嗜酸性粒细胞可能对 AECOPD 的个体化管理有价值。
